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LETTERS: Patrick Magennis and Anne Begley Teeth are rarely to blame BMJ 2008; 336: 464 [Full text]

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Dental pain

Enrique Castillo Betancourt MSc MDD, Eduardo curbeira Hernández MSc MDD   (5 March 2008)

Oral Hygiene

Hugh Mann   (6 March 2008)

Dental pain 5 March 2008
Enrique Castillo Betancourt MSc MDD, Dentistry Department Gustavo Aldereguia Lima University Hospital. Cienfuegos. Cuba. Postcode 55100, Eduardo curbeira Hernández MSc MDD Send response to journal: Re: Dental pain	Pain is a completely personal experience that cannot be shared and constitutes one of man's main concerns. It is the most common symptom for which we go to consult to the doctor. We have already said that since it is an experience that cannot be shared, applying identical painful stimuli to different individuals is perceived in a different way. We cannot feel the same thing exactly that another feels. In the face and in the mouth there is a great sensibility to pain. Odontologists must differentiate the source of the pain. Dental pain is one of the most annoying pains that a human being suffers, and it is the most frequent cause for which patients go to the dental clinic. The sensation of dental pain originates in the receptors located in the pulp (that is endowed with nervous fibers) or the dentin. The cement and the enamel are insensitive. When one observes the pain from, for example, a rotten tooth, we see that it is not localized clearly, the pain being referred to other areas. Dental pain presents a great variability in its characteristics and its intensity. The pain is described as an exasperating sensation. Even so, we should not assume that all dental pains is of pulpar or periodontal origin since the modulation of the pain can confuse the place of origin. This common phenomenon is referred pain, and the muscular pain or myalgia and articular pain or arthralgia, is maybe the biggest causing of false odontalgias. The behaviour and category of each pain can help us to understand its relationship and to arrive at one diagnosis. Periodontal pain is somatic superficial, of stimulating quality, of easy provocation and exact localization. Dental pain is somatic deep of visceral type and it is manifested diffuse and depressive, increases when being caused, hypermodulated and it has relationship with present pathology. Muscular and articular pains are also somatic deep, as a result of the inflammation or hyperactivity, they can be light to severe and their anatomical location can mask it as migraines, pain of hearing, articulations, cervical column or dental pain. The temporal muscles commonly refer to the superior teeth, the maseter muscles refer pain to the molars and superior and inferior bicuspids and the digastrics to the inferior previous teeth. The pains of neurological cause are spontaneous, they have point trigger, and they are stimulating, intense or persistent. The pains of psychological cause has an origin that don't have anatomical relationship and they are usually around 6 months duration (chronic), Bibliography 1. Magennis P, Begley A. Teeth are rarely to blame. BMJ 2008;336:464 (1 March). 2. D´Souza, Rena. DEVELOPMENT OF THE PULPODENTIN COMPLEX en Hargreaves, Kenneth M., Goodis, Harold E., Seltzer and Bender's Dental Pulp. Quintessence Books. Chicago. 2002: 13-40 3. Pashley D.F., Walton, R.E.. Histología y fisiología de la pulpa dental en Endodoncia. Ingle, J.I. & Taintor, J.F. 4ª ed. Mc Graw Hill Interamericana. México D.F. 1996: 337 4. Trowbridge, Henry et al. STRUCTURE AND FUNCTIONS OF THE DENTIN AND PULP COMPLEX en Cohen, Stephen, Burns, Richard C. Pathways of the Pulp. 8th.ed. Mosby. St. Louis 2002. 412- 6 Competing interests: None declared
Oral Hygiene 6 March 2008
Hugh Mann, Physician Eagle Rock, MO 65641 USA Send response to journal: Re: Oral Hygiene	Our mouth is teeming with bacteria that live on food which remains in our mouth after eating. Like all living organisms, these bacteria create waste products. As these waste products accumulate, they cause tooth decay and gum disease. The purpose of oral hygiene is to reduce the food, bacteria, and bacterial waste products in our mouth. This is why I recommend using an oral irrigator after every meal. I also recommend using an oscillating electric toothbrush at bedtime, having your teeth cleaned twice a year, and finding a dentist who recognizes the dangers of amalgams and metal dental work. Regular oral hygiene will save you from the nightmare of dental disease and painful dental treatments. Regular oral hygiene will enable you to chew your food, improve your appearance, and enjoy your life. Competing interests: None declared